COVID-19 is a respiratory infection caused by the SARS-CoV-2 virus, spread mainly through respiratory droplets and small airborne particles. Most people have a mild illness, but older adults and people with chronic disease or weak immunity can develop pneumonia, low oxygen and blood clots.
Key symptoms
- Fever, chills, cough and sore throat
- Fatigue, muscle aches and headache
- Loss of taste or smell
- Shortness of breath
- Nausea or diarrhea
What you find on exam
- Temperature, breathing rate and heart rate
- Oxygen saturation at rest and with walking
- Lung exam: crackles, signs of pneumonia
- Signs of dehydration or confusion in older adults
Tests
- Antigen test or PCR from a nasal swab
- Chest X-ray if short of breath or oxygen is low
- In hospital: blood count, metabolic panel, CRP, D-dimer and troponin as needed
- Test for influenza at the same time during flu season
Treatment basics
- Mild illness at home: rest, fluids, acetaminophen and isolation advice
- Nirmatrelvir with ritonavir within 5 days for high-risk patients; check drug interactions
- Remdesivir as an alternative, or molnupiravir if others cannot be used
- Hospital with low oxygen: oxygen, dexamethasone, remdesivir and clot prevention
- Vaccination to prevent severe disease
Red flags
- Oxygen saturation under 94 percent or trouble breathing
- Chest pain, confusion or bluish lips
- Cannot keep fluids down, or worsening after the first week
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Sources: NCCPA PANCE Content Blueprint; CDC, Guideline for Isolation Precautions (2007) and PPE sequence; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.